Challenges presented by the promotion criteria in Medical Teaching Institutes (MTIs) of Khyber Pakhtunkhwa (KP) to the research and academics of the faculty

Challenges presented by the promotion criteria in Medical Teaching Institutes (MTIs) of Khyber Pakhtunkhwa (KP) to the research and academics of the faculty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Challenges presented by the promotion criteria in Medical Teaching Institutes (MTIs) of Khyber Pakhtunkhwa (KP) to the research and academics of the faculty Musawer Khan, Usman Mahboob, Ambreen Syed, Saman Baseer, Fatima Abdul Qaiyum, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6187481/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: This research analyses the promotion challenges for faculty in Medical Teaching Institutes (MTIs) of Khyber Pakhtunkhwa (KP), Pakistan. The MTI Act prioritises research achievements, clinical skills, continuous professional development (CPD), and academic performance. However, faculty faces hurdles in meeting these criteria due to vague guidelines, overemphasising research publications, and insufficient institutional support. Objective: To identify challenges associated with faculty promotion in MTIs related to research and educational activities Methods: A qualitative study utilised semi-structured interviews with ten faculty members promoted or in the promotion process under MTI criteria and ten faculty promotion committee members. The data was analysed through the Cultural-Historical Activity Theory (CHAT) framework, concentrating on institutional, cultural, and historical factors affecting faculty experiences. Results: Eighteen codes and subthemes were identified, leading to twelve final themes. Key themes included ambiguities in promotion criteria, a focus on high-impact research, and difficulty balancing teaching, research, and clinical roles. Insufficient institutional support exacerbates these issues. The promotion criteria inadequately address local healthcare needs and undervalue community engagement. Discussion: The MTI faculty promotion criteria, differing from previous standards, emphasise research and academic activities. This criterion aligns with emerging trends in higher education but presents challenges. The focus on research leads to an imbalance in clinical commitments and educational activities. Additionally, limited resources, institutional culture, and support hinder faculty from meeting promotion criteria. Subjectivity surrounding specific requirements also raises concerns about transparent implementation. Conclusion: The research highlights the need to adjust MTI promotion standards to be adaptable and acknowledge local contributions. Improving transparency, supporting faculty development, and aligning with healthcare education goals are essential for a more effective academic environment. Faculty promotion Medical Teaching Institutes (MTIs) research challenges educational activities Cultural-Historical Activity Theory (CHAT) Figures Figure 1 Introduction Faculty promotion criteria are a cornerstone of academic advancement and institutional growth in medical education. Medical faculty members fulfil multifaceted roles, including teaching, clinical training, guiding research, and contributing to institutional development (Kruk et al., 2018 ). Faculty effectiveness and competence influence students' educational outcomes and reflect the quality of education and research within an institution (Salajegheh et al., 2022 ; Pololi et al., 2015 ). Consequently, faculty promotion systems foster academic productivity, encompassing teaching excellence, clinical expertise, and scholarly contributions (Passi et al., 2013 ). Globally, promotion criteria for faculty emphasise research productivity, often measured by the number of publications, as a critical determinant for advancement (Schimanski & Alperin, 2018 ). While research remains a vital component of academic productivity, an excessive focus on publication counts has raised concerns about the quality of research output, with issues such as predatory journals, ghost authorship, and low-impact publications increasingly prevalent (Werner, 2021 ; Janjua et al., 2022 ). Moreover, this overemphasis on research has sometimes overshadowed other critical domains, such as teaching excellence and clinical contributions (Cadez et al., 2017 ; Mukherjee, 2016 ). In Pakistan, faculty promotion criteria are regulated by the Pakistan Medical and Dental Council (PMDC), which outlines minimum requirements on tenure and publication output (Janjua et al., 2022 ). The introduction of the Medical Teaching Institutes (MTI) Act in Khyber Pakhtunkhwa (KP) revised these criteria, aiming to evaluate faculty on a broader spectrum of competencies, including research, clinical performance, academic achievements, and administrative roles. However, these revised criteria have introduced new challenges, particularly concerning the balance between research and educational responsibilities (Gilavand, 2016 ). Despite the importance of faculty promotion systems, limited research exists on the challenges faculty face in adapting to these evolving criteria, especially in developing contexts such as KP’s MTIs. This study seeks to identify and analyse the challenges related to faculty promotion criteria in MTIs, explicitly focusing on their impact on research and educational activities. The findings aim to provide evidence-based insights for policymakers to enhance faculty promotion systems, improve academic productivity, and strengthen the quality of medical education. Methodology Study Design This research employed a qualitative interpretive design with a phenomenological approach to explore and analyse the lived experiences of faculty members and promotion committee members within Medical Teaching Institutes (MTIs) in Khyber Pakhtunkhwa (KP). This design was chosen to deeply understand the challenges presented by faculty promotion criteria, particularly their impact on educational and research activities. Phenomenological methods allow for an in-depth exploration of personal experiences, helping identify existing policies' deficiencies or challenges and propose evidence-based solutions. Setting and Participants The study was conducted within MTIs in KP, Pakistan. Participants included: Ten faculty members who had either successfully been promoted or were in the process of promotion under the MTI criteria. Ten members of MTI faculty promotion committees. Participants were selected using purposive sampling , ensuring they had direct experience with the promotion criteria and could provide rich, relevant insights. Ethical Considerations Ethical approval was obtained from the institutional review board of the respective MTI. All participants gave informed consent, ensuring confidentiality and voluntary participation. Data were anonymised, and findings were reported using pseudonyms. Data Collection Data were collected through semi-structured in-person or virtual interview s, depending on participant availability. The interview guide was specially designed for this research study after thorough discussions with medical education and research experts. The interview guide focused on: Perceptions of the faculty promotion criteria. Challenges experienced during the promotion process. Impacts on educational and research responsibilities. Interviews were audio-recorded with participant consent and transcribed verbatim for analysis. Field notes were also maintained to capture non-verbal cues and contextual details. Data Analysis The data were analysed using a thematic approach underpinned by the Cultural-Historical Activity Theory (CHAT) framework. This involved: Open Coding : Initial coding to identify key phrases and concepts in the transcripts. Axial Coding : Grouping related codes into subcategories and categories. Theme Development : Synthesizing categories into overarching themes that reflect the central findings. Representative quotes from participants illustrated themes and subthemes. The analysis focused on understanding systemic contradictions, tensions, and enablers affecting faculty promotion criteria and their outcomes. Results Characteristics of Participants The study included interviews with ten faculty members and ten promotion committee members from various MTIs in KP (Table 1 ). The participants represented diverse experiences and perspectives regarding the implementation and impact of the new promotion criteria. Table 1 Demographics of the Participants MTI included Number of Faculty members interviewed Number of Promotion committee members interviewed Mardan medical complex/Bacha khan Medical College, Mardan 4 4 Hayat Abad Medical Complex, Peshawar 4 2 Lady Reading Hospital, Peshawar 2 2 Gajju Khan Medical College, Swabi 0 2 Total 10 10 Analysis Using CHAT Framework CHAT provided a systematic approach to analysing the promotion criteria. The themes and contradictions identified were as follows (Fig. 1 ): 1. Activity System Components: Faculty members (subjects) navigate promotion criteria (object) influenced by institutional policies and cultural norms (community). Tools like criteria documents were perceived as unclear and misaligned with faculty roles, hindering academic engagement. 2. Contradictions and Tensions: Fundamental contradictions included an overemphasis on publications at the expense of clinical and teaching responsibilities. Rigid curricula and outdated practices exacerbated these tensions. 3. Opportunities for Transformation: Faculty advocated for revisions to the criteria, emphasising flexibility, local research recognition, and support for community engagement. Key Findings The analysis identified several critical challenges associated with the faculty promotion criteria in Khyber Pakhtunkhwa's (KP) Medical Teaching Institutes (MTIs). These challenges, derived from interviews with faculty and promotion committee members, were explored using the Cultural-Historical Activity Theory (CHAT) framework. The findings are organised under main themes, with representative quotes and analysis provided (Table 2 & Table 3 ). 1. Ambiguities and Subjectivity in Promotion Criteria: Faculty members reported needing more clarity and transparency in the promotion criteria. Subjectivity in evaluation processes leads to perceptions of favouritism. Overemphasis on high-impact publications was also noted, contributing to stress and the potential for unethical practices. 2. Challenges in Balancing Roles: The criteria heavily emphasise research, creating significant workload imbalances. Faculty members struggle to meet the demands of teaching, research, and clinical responsibilities, negatively impacting academic performance and patient care. 3. Cultural Resistance and Historical Practices: A weak research culture in MTIs was linked to historical practices that undervalued academic contributions. Faculty members expressed difficulties adapting to new criteria, particularly given the cultural inertia in prioritising clinical over academic roles. 4. Misalignment with Local Needs: The promotion criteria were perceived as poorly aligned with local healthcare priorities and needed recognition of community engagement. Faculty advocated for more contextually relevant criteria for local research contributions and realities. 5. Resource Constraints: Inadequate infrastructure, funding, and mentorship were significant barriers to achieving the promotion benchmarks. Faculty members stressed the need for more incredible institutional support to foster academic growth and research productivity. Table 2 Themes Identified with Subthemes, Open Coding, and Axial Coding Main Themes Subthemes Open Coding Axial Coding Promotion Criteria Understanding Lack of Clarity Ambiguities in criteria, subjective evaluation Lack of transparency Overemphasis on Research Heavy reliance on high-impact journals Pressure on faculty Teaching and Research Challenges Balancing Responsibilities Struggles with clinical, teaching, and research Workload imbalance Cultural Influences Disconnect with Real-World Needs Promotion criteria not tailored to local realities Frustration with misalignment Lack of Research Culture Weak emphasis on research development Reliance on outdated practices Table 3 Representative Quotes and Analysis Theme Representative Quotes Insights/Analysis Lack of Clarity in Criteria "The criteria lack clarity and transparency." Ambiguities lead to subjective evaluations and potential favoritism in promotions. Overemphasis on Research "There is a heavy focus on research publications." Excessive focus on high-impact journals causes stress and hinders holistic faculty development. Balancing Responsibilities "Balancing teaching and clinical duties is a challenge." Faculty workload imbalance impacts both academic and clinical performance. Disconnect with Local Needs "The criteria could be more relevant to our context." Misalignment with healthcare priorities limits faculty engagement and regional research impact. Discussion This study aimed to explore the challenges faced by faculty members in the Medical Teaching Institutes (MTIs) of Khyber Pakhtunkhwa (KP) regarding the MTI faculty promotion criteria. By applying the Cultural-Historical Activity Theory (CHAT), this research examined the interactions within a complex activity system, incorporating the perspectives of individual faculty members, promotion committees, and the broader institutional context. The findings highlighted several barriers that hinder the effective implementation of the promotion criteria and significantly impact faculty members’ academic and research activities. Changes in the Promotion Criteria Before implementing the MTI Act 2015, faculty promotions were primarily based on tenure and the number of research publications. However, the MTI Act introduced more comprehensive criteria, including excellence in teaching, clinical performance, personal and professional development, and participation in continuous medical education (CME). These reforms aimed to improve the quality of medical education and patient care in KP’s tertiary healthcare hospitals by aligning faculty promotion with the broader institutional mission. However, implementing these new promotion criteria posed significant challenges for faculty members, especially in balancing the increasing demands of research, teaching, and clinical responsibilities. Subjectivity in Promotion Criteria One of the main challenges identified by faculty members was the ambiguity and subjectivity in interpreting specific academic requirements. Ambiguities regarding educational and research requirements led to varied interpretations among faculty members and promotion committees. As noted by Tootoonchi et al. ( 2014 ), evaluating teaching effectiveness is a complex task, and existing evaluation methods often need to adequately capture the quality of teaching. In MTIs, this issue is further compounded by the assumption that teaching skills are inherent rather than developed through continuous professional growth. Faculty members expressed concerns that the lack of clear guidelines led to subjective evaluations, contributing to a perception of favouritism in the promotion process. Overemphasis on Research Publications Another significant challenge identified was the overemphasis on publishing in high-impact journals as part of the promotion criteria. The MTI promotion system placed considerable value on publishing research in Impact Factor Journals (IFJ), which increased pressure on faculty members to produce research output at the expense of other academic responsibilities. The literature has widely critiqued the emphasis on quantity over quality in publications (Tijdink et al., 2016 ; Stürmer et al., 2017 ). This pressure has resulted in unethical practices, such as the publication of papers in predatory journals, and has contributed to a perception of research being a checkbox activity rather than a meaningful intellectual endeavour. As Quan et al. (n.d.) pointed out, a more balanced approach that considers the quality and relevance of research rather than just the quantity of publications is essential to ensure the integrity and impact of scholarly work. Balancing Research and Clinical Duties The dual burden of fulfilling clinical and research duties emerged as another critical challenge. Faculty members in MTIs are responsible for clinical care in busy hospitals while meeting the demands of the promotion criteria for research and teaching. As noted by Simpson et al. ( 2007 ), this dual responsibility can detract from their ability to focus on either aspect, resulting in suboptimal performance in both areas. The heavy workload placed on faculty members, particularly in high-pressure clinical environments, often compromises patient care and hinders the ability to engage in high-quality research and teaching. This tension between clinical duties and academic responsibilities has been well-documented in other studies (Moher et al., 2018 b; Zibrowski et al., 2008 ) and further highlights the need for a more sustainable workload balance within MTIs. Institutional Support and Resources The need for more institutional support and infrastructure for research and teaching was also highlighted as a significant barrier. Faculty members reported that the MTI promotion criteria demanded excellence in areas where the necessary resources, such as research funding, teaching facilities, and administrative support, were insufficient. According to Majini and Bella ( 2024 ), investing in faculty development, modern classrooms, and collaborative spaces is crucial for fostering an academic environment conducive to research and teaching excellence. Without these resources, faculty members are left to navigate the promotion criteria without adequate support, undermining their ability to meet the standards set by the MTI Act. Cultural Adaptation and Flexibility in Promotion Criteria The sudden and significant shift in the promotion criteria from the previous tenure-based system to a more research and education-focused system posed a cultural adaptation challenge within MTIs. As Salajegheh et al. ( 2020 ) noted, faculty members struggled to adapt to the new criteria, which they perceived as unrealistic given the current infrastructure and workload demands. This cultural resistance was exacerbated by the lack of flexibility in the requirements, with faculty members advocating for criteria more aligned with local needs and realities. There was a consensus that local journals should be recognised more as they reflect the region’s health needs. Collaborative research efforts should be equally valued rather than solely on individual achievements (Mazumdar et al., 2015 ). This calls for a more contextually appropriate approach to faculty promotion that considers faculty members' unique challenges in MTIs. Recommendations for Improvement To address these challenges, faculty members recommended revising the MTI promotion criteria to ensure they are more realistic and supportive of the local context. It was suggested that the promotion system should be more flexible, with due recognition given to local journals and collaborative research. Additionally, faculty members should be provided with more resources and institutional support to help them balance their teaching, research, and clinical responsibilities. This could include facilitating workshops, providing research funding, and improving the availability of teaching resources. Incorporating feedback from faculty members as stakeholders in revising the promotion criteria will also ensure the requirements are relevant and feasible (Shafian & Salajegheh, 2021 ). Limitations of the Study While this study provides valuable insights into the challenges faced by faculty members in MTIs, it has several limitations. The research was conducted in only a few MTIs, and the views of faculty members from all MTIs were not included. Additionally, the study focused on clinical faculty, and the challenges faced by faculty in Basic Sciences were not explored. Further research is needed to examine the challenges faculty face in other departments and evaluate the MTI promotion criteria more holistically, considering clinical, administrative, and educational factors. Conclusion This study highlights the complex challenges faculty members face in Khyber Pakhtunkhwa's MTIs in meeting the demands of the MTI promotion criteria. The findings underscore the need for a more balanced, flexible, and supportive approach to faculty promotion that considers faculty members' diverse roles and responsibilities and the unique challenges of working in MTIs. Revising the promotion criteria, in consultation with faculty members, will be crucial to fostering an environment that supports faculty academic and professional development while improving medical education and patient care. Abbreviations MTIs: Medical Teaching Institutes KP: Khyber Pakhtunkhwa CPD: Continuous Professional Development CHAT: Cultural-Historical Activity Theory PMDC : Pakistan Medical and Dental Council CME: Continuous Medical Education Declarations Ethics approval and consent to participate : The research was conducted after getting approval from the “ Institute of Health Professions Education, Khyber Medical University, Peshawar.” Via Ref No: 1-12/IHPER/MHPE/KMU/24-11 on Dated: 14-06-2024. The study was conducted after obtaining informed consent from the participants and in compliance with the “Declaration of Helsinki”. Consent for publication: Consent for publication was obtained along with permission from the participants to participate. Availability of data and materials : The datasets used and/or analysed during the current study are available from the original submitting author (Musawer Khan, Email: [email protected] ) on reasonable request. Competing interests : Authors report no competing interest in conducting or publishing this research. Funding: N/A (This was qualitative research with meagre financial requirements). Authors Contributions: Sr.# Author’s Full Name Intellectual Contribution to Paper in Terms of: 1. Musawer Khan 1. Study design and methodology 2. Usman Mahboob 2. Paper writing 3. Ambreen Syed 3. Data collection and calculations 4. Saman Baseer 4. Analysis of data and interpretation of results 5. Fatima Abdul Qaiyum 5. Literature review and referencing 6. Bushra Mehboob 6. Editing and quality insurer References Cadez, S., Dimovski, V., & Zaman Groff, M. (2017). Research, teaching and performance evaluation in academia: the salience of quality. Studies in Higher Education, 42(8), 1455–1473. https://doi.org/10.1080/03075079.2015.1104659 Gilavand, A. (2016). 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A qualitative focus group interview study among Dutch biomedical researchers. BMJ Open, 6(2). https://doi.org/10.1136/bmjopen-2015 Tootoonchi, M., Yamani, N., Changiz, T., Taleghani, F., & Mohammadzadeh, Z. (2014). Assessment of educational criteria in academic promotion: Perspectives of faculty members of medical sciences universities in Iran. Journal of Education and Health Promotion, 3(1), 29. https://doi.org/10.4103/2277-9531.131893 Werner, M. U. (2021). Salami-slicing and duplicate publication: Gatekeepers challenges. In Scandinavian Journal of Pain (Vol. 21, Issue 2, pp. 209–211). De Gruyter Open Ltd. https://doi.org/10.1515/sjpain-2020-0181 Zibrowski, E. M., Weston, W. W., & Goldszmidt, M. A. (2008). “I don’t have time”: issues of fragmentation, prioritisation and motivation for education scholarship among medical faculty. Medical Education, 42(9), 872–878. https://doi.org/10.1111/J.1365-2923.2008.03 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6187481","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":445776273,"identity":"58eefea1-e755-48bd-80f2-6a95078eb502","order_by":0,"name":"Musawer Khan","email":"","orcid":"","institution":"Mardan Medical Complex/Bacha Khan Medical College, Mardan, KP, Pakistan","correspondingAuthor":false,"prefix":"","firstName":"Musawer","middleName":"","lastName":"Khan","suffix":""},{"id":445776274,"identity":"bcc19550-1b33-4d9a-8853-734981d0e29f","order_by":1,"name":"Usman Mahboob","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYDADAwkGBmaGigQwRwIkQKSWMyRrYWwjQovB+dOJnwsYtsmbSzcffFw4Ly3a4ADzwds8DHeMcWq5kbtZegbDbcOdc44lG8/clpO74QBbsjUPwzMz3Fp4N0jzMNxm3HAjx0yad1sFUAuPGVDksA1uh53d/BuoxR6iZQ5IC/83/FoO5G4D2ZII0dIAchgPG0gLTodJ3sjdZs1jcDt5wx2gX2YcS8udeZjN2HKOwTOc3ucDOuw2T8Vt2w23gSFWUJOc23e8+eGNNxV3DBtw6YE4D5nDDHEwXg1YARlaRsEoGAWjYLgCAFXZW5GFuL0FAAAAAElFTkSuQmCC","orcid":"","institution":"Khyber Medical University","correspondingAuthor":true,"prefix":"","firstName":"Usman","middleName":"","lastName":"Mahboob","suffix":""},{"id":445776275,"identity":"bad87f00-76f4-448f-a5e6-093cd17b60e9","order_by":2,"name":"Ambreen Syed","email":"","orcid":"","institution":"Hayatabad Medical Complex","correspondingAuthor":false,"prefix":"","firstName":"Ambreen","middleName":"","lastName":"Syed","suffix":""},{"id":445776276,"identity":"ed7a6cae-bc0f-4a2d-be4a-0f909c7adf27","order_by":3,"name":"Saman Baseer","email":"","orcid":"","institution":"Gandhara University","correspondingAuthor":false,"prefix":"","firstName":"Saman","middleName":"","lastName":"Baseer","suffix":""},{"id":445776277,"identity":"24522cbb-cc15-4a89-ac65-cdc70d44054e","order_by":4,"name":"Fatima Abdul Qaiyum","email":"","orcid":"","institution":"Riphah International University","correspondingAuthor":false,"prefix":"","firstName":"Fatima","middleName":"Abdul","lastName":"Qaiyum","suffix":""},{"id":445776278,"identity":"01c40045-754f-4b2a-9566-beb272179f41","order_by":5,"name":"Bushra Mehboob","email":"","orcid":"","institution":"Riphah International University","correspondingAuthor":false,"prefix":"","firstName":"Bushra","middleName":"","lastName":"Mehboob","suffix":""}],"badges":[],"createdAt":"2025-03-09 08:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6187481/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6187481/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81281702,"identity":"b9290db6-2523-41fd-971c-1a5eba2dacf4","added_by":"auto","created_at":"2025-04-24 10:16:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":226901,"visible":true,"origin":"","legend":"\u003cp\u003eA model of Cultural-Historical Activity Theory Redrawn, with modification from Engstrom (Mahboob, 2014).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6187481/v1/fff8c60c927a0e0d99c636cf.png"},{"id":83743474,"identity":"0eae1738-547a-4400-9c9c-b180a287bfb9","added_by":"auto","created_at":"2025-06-02 02:31:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1193631,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6187481/v1/cf04c22d-c8de-42b4-a4e3-463cc58fabc6.pdf"},{"id":81281706,"identity":"d24fc40f-5ab9-43f8-8d36-20c2b6dd2607","added_by":"auto","created_at":"2025-04-24 10:16:07","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":17466,"visible":true,"origin":"","legend":"","description":"","filename":"questionnairesdevelopedfor22DrMusawers22Research.docx","url":"https://assets-eu.researchsquare.com/files/rs-6187481/v1/c9ebd0ffdaa0d30b1a38e5e6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Challenges presented by the promotion criteria in Medical Teaching Institutes (MTIs) of Khyber Pakhtunkhwa (KP) to the research and academics of the faculty","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFaculty promotion criteria are a cornerstone of academic advancement and institutional growth in medical education. Medical faculty members fulfil multifaceted roles, including teaching, clinical training, guiding research, and contributing to institutional development (Kruk et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Faculty effectiveness and competence influence students' educational outcomes and reflect the quality of education and research within an institution (Salajegheh et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Pololi et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Consequently, faculty promotion systems foster academic productivity, encompassing teaching excellence, clinical expertise, and scholarly contributions (Passi et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, promotion criteria for faculty emphasise research productivity, often measured by the number of publications, as a critical determinant for advancement (Schimanski \u0026amp; Alperin, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). While research remains a vital component of academic productivity, an excessive focus on publication counts has raised concerns about the quality of research output, with issues such as predatory journals, ghost authorship, and low-impact publications increasingly prevalent (Werner, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Janjua et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Moreover, this overemphasis on research has sometimes overshadowed other critical domains, such as teaching excellence and clinical contributions (Cadez et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Mukherjee, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Pakistan, faculty promotion criteria are regulated by the Pakistan Medical and Dental Council (PMDC), which outlines minimum requirements on tenure and publication output (Janjua et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The introduction of the Medical Teaching Institutes (MTI) Act in Khyber Pakhtunkhwa (KP) revised these criteria, aiming to evaluate faculty on a broader spectrum of competencies, including research, clinical performance, academic achievements, and administrative roles. However, these revised criteria have introduced new challenges, particularly concerning the balance between research and educational responsibilities (Gilavand, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the importance of faculty promotion systems, limited research exists on the challenges faculty face in adapting to these evolving criteria, especially in developing contexts such as KP\u0026rsquo;s MTIs. This study seeks to identify and analyse the challenges related to faculty promotion criteria in MTIs, explicitly focusing on their impact on research and educational activities. The findings aim to provide evidence-based insights for policymakers to enhance faculty promotion systems, improve academic productivity, and strengthen the quality of medical education.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis research employed a \u003cb\u003equalitative interpretive design\u003c/b\u003e with a phenomenological approach to explore and analyse the lived experiences of faculty members and promotion committee members within Medical Teaching Institutes (MTIs) in Khyber Pakhtunkhwa (KP). This design was chosen to deeply understand the challenges presented by faculty promotion criteria, particularly their impact on educational and research activities. Phenomenological methods allow for an in-depth exploration of personal experiences, helping identify existing policies' deficiencies or challenges and propose evidence-based solutions.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting and Participants\u003c/h3\u003e\n\u003cp\u003eThe study was conducted within MTIs in KP, Pakistan. Participants included:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTen faculty members who had either successfully been promoted or were in the process of promotion under the MTI criteria.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTen members of MTI faculty promotion committees.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eParticipants were selected using \u003cb\u003epurposive sampling\u003c/b\u003e, ensuring they had direct experience with the promotion criteria and could provide rich, relevant insights.\u003c/p\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eEthical approval was obtained from the institutional review board of the respective MTI. All participants gave informed consent, ensuring confidentiality and voluntary participation. Data were anonymised, and findings were reported using pseudonyms.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData were collected through \u003cb\u003esemi-structured in-person or virtual interview\u003c/b\u003es, depending on participant availability. The interview guide was specially designed for this research study after thorough discussions with medical education and research experts. The interview guide focused on:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePerceptions of the faculty promotion criteria.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eChallenges experienced during the promotion process.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eImpacts on educational and research responsibilities.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eInterviews were audio-recorded with participant consent and transcribed verbatim for analysis. Field notes were also maintained to capture non-verbal cues and contextual details.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe data were analysed using a \u003cb\u003ethematic approach\u003c/b\u003e underpinned by the \u003cb\u003eCultural-Historical Activity Theory (CHAT)\u003c/b\u003e framework. This involved:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eOpen Coding\u003c/b\u003e: Initial coding to identify key phrases and concepts in the transcripts.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eAxial Coding\u003c/b\u003e: Grouping related codes into subcategories and categories.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTheme Development\u003c/b\u003e: Synthesizing categories into overarching themes that reflect the central findings.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eRepresentative quotes from participants illustrated themes and subthemes. The analysis focused on understanding systemic contradictions, tensions, and enablers affecting faculty promotion criteria and their outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of Participants\u003c/h2\u003e \u003cp\u003eThe study included interviews with ten faculty members and ten promotion committee members from various MTIs in KP (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The participants represented diverse experiences and perspectives regarding the implementation and impact of the new promotion criteria.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of the Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMTI included\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Faculty members interviewed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of Promotion committee members interviewed\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMardan medical complex/Bacha khan Medical College, Mardan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHayat Abad Medical Complex, Peshawar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLady Reading Hospital, Peshawar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGajju Khan Medical College, Swabi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnalysis Using CHAT Framework\u003c/h3\u003e\n\u003cp\u003eCHAT provided a systematic approach to analysing the promotion criteria. The themes and contradictions identified were as follows (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e1. Activity System Components:\u003c/h2\u003e \u003cp\u003eFaculty members (subjects) navigate promotion criteria (object) influenced by institutional policies and cultural norms (community). Tools like criteria documents were perceived as unclear and misaligned with faculty roles, hindering academic engagement.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2. Contradictions and Tensions:\u003c/h2\u003e \u003cp\u003eFundamental contradictions included an overemphasis on publications at the expense of clinical and teaching responsibilities. Rigid curricula and outdated practices exacerbated these tensions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3. Opportunities for Transformation:\u003c/h2\u003e \u003cp\u003eFaculty advocated for revisions to the criteria, emphasising flexibility, local research recognition, and support for community engagement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eKey Findings\u003c/h2\u003e \u003cp\u003eThe analysis identified several critical challenges associated with the faculty promotion criteria in Khyber Pakhtunkhwa's (KP) Medical Teaching Institutes (MTIs). These challenges, derived from interviews with faculty and promotion committee members, were explored using the Cultural-Historical Activity Theory (CHAT) framework. The findings are organised under main themes, with representative quotes and analysis provided (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u0026amp; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e1. Ambiguities and Subjectivity in Promotion Criteria:\u003c/h2\u003e \u003cp\u003eFaculty members reported needing more clarity and transparency in the promotion criteria. Subjectivity in evaluation processes leads to perceptions of favouritism. Overemphasis on high-impact publications was also noted, contributing to stress and the potential for unethical practices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e2. Challenges in Balancing Roles:\u003c/h2\u003e \u003cp\u003eThe criteria heavily emphasise research, creating significant workload imbalances. Faculty members struggle to meet the demands of teaching, research, and clinical responsibilities, negatively impacting academic performance and patient care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3. Cultural Resistance and Historical Practices:\u003c/h2\u003e \u003cp\u003eA weak research culture in MTIs was linked to historical practices that undervalued academic contributions. Faculty members expressed difficulties adapting to new criteria, particularly given the cultural inertia in prioritising clinical over academic roles.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4. Misalignment with Local Needs:\u003c/h2\u003e \u003cp\u003eThe promotion criteria were perceived as poorly aligned with local healthcare priorities and needed recognition of community engagement. Faculty advocated for more contextually relevant criteria for local research contributions and realities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e5. Resource Constraints:\u003c/h2\u003e \u003cp\u003eInadequate infrastructure, funding, and mentorship were significant barriers to achieving the promotion benchmarks. Faculty members stressed the need for more incredible institutional support to foster academic growth and research productivity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes Identified with Subthemes, Open Coding, and Axial Coding\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain Themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubthemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOpen Coding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAxial Coding\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePromotion Criteria Understanding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLack of Clarity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmbiguities in criteria, subjective evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLack of transparency\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOveremphasis on Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHeavy reliance on high-impact journals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePressure on faculty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching and Research Challenges\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBalancing Responsibilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStruggles with clinical, teaching, and research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorkload imbalance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCultural Influences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisconnect with Real-World Needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePromotion criteria not tailored to local realities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrustration with misalignment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLack of Research Culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWeak emphasis on research development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReliance on outdated practices\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRepresentative Quotes and Analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRepresentative Quotes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInsights/Analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of Clarity in Criteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"The criteria lack clarity and transparency.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmbiguities lead to subjective evaluations and potential favoritism in promotions.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOveremphasis on Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"There is a heavy focus on research publications.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExcessive focus on high-impact journals causes stress and hinders holistic faculty development.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBalancing Responsibilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Balancing teaching and clinical duties is a challenge.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFaculty workload imbalance impacts both academic and clinical performance.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisconnect with Local Needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"The criteria could be more relevant to our context.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMisalignment with healthcare priorities limits faculty engagement and regional research impact.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to explore the challenges faced by faculty members in the Medical Teaching Institutes (MTIs) of Khyber Pakhtunkhwa (KP) regarding the MTI faculty promotion criteria. By applying the Cultural-Historical Activity Theory (CHAT), this research examined the interactions within a complex activity system, incorporating the perspectives of individual faculty members, promotion committees, and the broader institutional context. The findings highlighted several barriers that hinder the effective implementation of the promotion criteria and significantly impact faculty members\u0026rsquo; academic and research activities.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eChanges in the Promotion Criteria\u003c/h2\u003e \u003cp\u003eBefore implementing the MTI Act 2015, faculty promotions were primarily based on tenure and the number of research publications. However, the MTI Act introduced more comprehensive criteria, including excellence in teaching, clinical performance, personal and professional development, and participation in continuous medical education (CME). These reforms aimed to improve the quality of medical education and patient care in KP\u0026rsquo;s tertiary healthcare hospitals by aligning faculty promotion with the broader institutional mission. However, implementing these new promotion criteria posed significant challenges for faculty members, especially in balancing the increasing demands of research, teaching, and clinical responsibilities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSubjectivity in Promotion Criteria\u003c/h2\u003e \u003cp\u003eOne of the main challenges identified by faculty members was the ambiguity and subjectivity in interpreting specific academic requirements. Ambiguities regarding educational and research requirements led to varied interpretations among faculty members and promotion committees. As noted by Tootoonchi et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), evaluating teaching effectiveness is a complex task, and existing evaluation methods often need to adequately capture the quality of teaching. In MTIs, this issue is further compounded by the assumption that teaching skills are inherent rather than developed through continuous professional growth. Faculty members expressed concerns that the lack of clear guidelines led to subjective evaluations, contributing to a perception of favouritism in the promotion process.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eOveremphasis on Research Publications\u003c/h2\u003e \u003cp\u003eAnother significant challenge identified was the overemphasis on publishing in high-impact journals as part of the promotion criteria. The MTI promotion system placed considerable value on publishing research in Impact Factor Journals (IFJ), which increased pressure on faculty members to produce research output at the expense of other academic responsibilities. The literature has widely critiqued the emphasis on quantity over quality in publications (Tijdink et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; St\u0026uuml;rmer et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This pressure has resulted in unethical practices, such as the publication of papers in predatory journals, and has contributed to a perception of research being a checkbox activity rather than a meaningful intellectual endeavour. As Quan et al. (n.d.) pointed out, a more balanced approach that considers the quality and relevance of research rather than just the quantity of publications is essential to ensure the integrity and impact of scholarly work.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eBalancing Research and Clinical Duties\u003c/h2\u003e \u003cp\u003eThe dual burden of fulfilling clinical and research duties emerged as another critical challenge. Faculty members in MTIs are responsible for clinical care in busy hospitals while meeting the demands of the promotion criteria for research and teaching. As noted by Simpson et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), this dual responsibility can detract from their ability to focus on either aspect, resulting in suboptimal performance in both areas. The heavy workload placed on faculty members, particularly in high-pressure clinical environments, often compromises patient care and hinders the ability to engage in high-quality research and teaching. This tension between clinical duties and academic responsibilities has been well-documented in other studies (Moher et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003eb; Zibrowski et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) and further highlights the need for a more sustainable workload balance within MTIs.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eInstitutional Support and Resources\u003c/h2\u003e \u003cp\u003eThe need for more institutional support and infrastructure for research and teaching was also highlighted as a significant barrier. Faculty members reported that the MTI promotion criteria demanded excellence in areas where the necessary resources, such as research funding, teaching facilities, and administrative support, were insufficient. According to Majini and Bella (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), investing in faculty development, modern classrooms, and collaborative spaces is crucial for fostering an academic environment conducive to research and teaching excellence. Without these resources, faculty members are left to navigate the promotion criteria without adequate support, undermining their ability to meet the standards set by the MTI Act.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eCultural Adaptation and Flexibility in Promotion Criteria\u003c/h2\u003e \u003cp\u003eThe sudden and significant shift in the promotion criteria from the previous tenure-based system to a more research and education-focused system posed a cultural adaptation challenge within MTIs. As Salajegheh et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) noted, faculty members struggled to adapt to the new criteria, which they perceived as unrealistic given the current infrastructure and workload demands. This cultural resistance was exacerbated by the lack of flexibility in the requirements, with faculty members advocating for criteria more aligned with local needs and realities. There was a consensus that local journals should be recognised more as they reflect the region\u0026rsquo;s health needs. Collaborative research efforts should be equally valued rather than solely on individual achievements (Mazumdar et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). This calls for a more contextually appropriate approach to faculty promotion that considers faculty members' unique challenges in MTIs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eRecommendations for Improvement\u003c/h2\u003e \u003cp\u003eTo address these challenges, faculty members recommended revising the MTI promotion criteria to ensure they are more realistic and supportive of the local context. It was suggested that the promotion system should be more flexible, with due recognition given to local journals and collaborative research. Additionally, faculty members should be provided with more resources and institutional support to help them balance their teaching, research, and clinical responsibilities. This could include facilitating workshops, providing research funding, and improving the availability of teaching resources. Incorporating feedback from faculty members as stakeholders in revising the promotion criteria will also ensure the requirements are relevant and feasible (Shafian \u0026amp; Salajegheh, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the Study\u003c/h2\u003e \u003cp\u003eWhile this study provides valuable insights into the challenges faced by faculty members in MTIs, it has several limitations. The research was conducted in only a few MTIs, and the views of faculty members from all MTIs were not included. Additionally, the study focused on clinical faculty, and the challenges faced by faculty in Basic Sciences were not explored. Further research is needed to examine the challenges faculty face in other departments and evaluate the MTI promotion criteria more holistically, considering clinical, administrative, and educational factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the complex challenges faculty members face in Khyber Pakhtunkhwa's MTIs in meeting the demands of the MTI promotion criteria. The findings underscore the need for a more balanced, flexible, and supportive approach to faculty promotion that considers faculty members' diverse roles and responsibilities and the unique challenges of working in MTIs. Revising the promotion criteria, in consultation with faculty members, will be crucial to fostering an environment that supports faculty academic and professional development while improving medical education and patient care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eMTIs:\u0026nbsp;\u003c/strong\u003eMedical Teaching Institutes\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKP:\u0026nbsp;\u003c/strong\u003eKhyber Pakhtunkhwa\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCPD:\u0026nbsp;\u003c/strong\u003eContinuous Professional Development\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCHAT:\u0026nbsp;\u003c/strong\u003eCultural-Historical Activity Theory\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePMDC\u003c/strong\u003e: \u0026nbsp;Pakistan Medical and Dental Council\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCME:\u003c/strong\u003e\u0026nbsp; Continuous Medical Education\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe research was conducted after getting approval from the “ Institute of Health Professions Education, Khyber Medical University, Peshawar.” Via Ref No: 1-12/IHPER/MHPE/KMU/24-11 on Dated: 14-06-2024. The study was conducted after obtaining informed consent from the participants and in compliance with the “Declaration of Helsinki”.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Consent for publication was obtained along with permission from the participants to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e \u0026nbsp;The datasets used and/or analysed during the current study are available from the original submitting author (Musawer Khan, Email: [email protected]) on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eAuthors report no competing interest in conducting or publishing this research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eN/A (This was qualitative research with meagre financial requirements).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions:\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"556\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSr.#\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor’s Full Name\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIntellectual Contribution to Paper in Terms of:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;Musawer Khan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.\u0026nbsp; \u0026nbsp;Study design and methodology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUsman Mahboob\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.\u0026nbsp; \u0026nbsp;Paper writing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;Ambreen Syed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.\u0026nbsp; \u0026nbsp;Data collection and calculations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSaman Baseer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.\u0026nbsp; \u0026nbsp;Analysis of data and interpretation of results\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;Fatima Abdul Qaiyum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.\u0026nbsp; \u0026nbsp;Literature review and referencing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBushra Mehboob\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.\u0026nbsp; \u0026nbsp;Editing and quality insurer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCadez, S., Dimovski, V., \u0026amp; Zaman Groff, M. (2017). Research, teaching and performance evaluation in academia: the salience of quality. Studies in Higher Education, 42(8), 1455\u0026ndash;1473. https://doi.org/10.1080/03075079.2015.1104659\u003c/li\u003e\n\u003cli\u003eGilavand, A. (2016). Pathology of Faculty Members\u0026rsquo; rank Promotion in Universities and Higher Education Institutions Affiliated to the Ministry of Health and Medical Education of the Islamic Republic of Iran. International Journal of Medical Research \u0026amp; Health Sciences, pp. 5, 25\u0026ndash;30. www.ijmrhs.com\u003c/li\u003e\n\u003cli\u003eJanjua, M. R. S., Janjua, J., Muazam, S., \u0026amp; Wajid, G. (2022). Perceptions of faculty on promotion policy in medical and dental colleges associated with Shaheed Zulfiqar Ali Bhutto Medical University Islamabad, Pakistan. Journal of the Pakistan Medical Association, 72(5), 866\u0026ndash;873. https://doi.org/10.47391/JPMA.2222\u003c/li\u003e\n\u003cli\u003eKruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., Adeyi, O., Barker, P., Daelmans, B., Doubova, S. V., English, M., Elorrio, E. G., Guanais, F., Gureje, O., Hirschhorn, L. R., Jiang, L., Kelley, E., Lemango, E. T., Liljestrand, J., \u0026hellip; Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era: time for a revolution. In The Lancet Global Health (Vol. 6, Issue 11, pp. e1196\u0026ndash;e1252). Elsevier Ltd. https://doi.org/10.1016/S2214-109X(18)30386-3\u003c/li\u003e\n\u003cli\u003eMahboob, U. (2014). How do medical students and clinical faculty members from two different cultures perceive professionalism? DHPE thesis. https://theses.gla.ac.uk/8913/\u003c/li\u003e\n\u003cli\u003eMajini, K., \u0026amp; Bella, J. (2024). A STUDY ON INSTITUTIONAL INFRASTRUCTURE AND FACILITIES FOR FACULTY. https://www.researchgate.net/publication/379412098\u003c/li\u003e\n\u003cli\u003eMazumdar, M., Messinger, S., Finkelstein, D. M., Goldberg, J. D., Lindsell, C. J., Morton, S. C., Pollock, B. H., Rahbar, M. H., Welty, L. J., Parker, R. A., Ash, A., Carter, R., Delong, E., Fox, E., Heagerty, P., Kopras, E., Macaluso, M., Mayo, M. S., Oster, R., \u0026hellip; Carey, T. (2015). Evaluating Academic Scientists Collaborating in Team-Based Research: A Proposed Framework. Academic Medicine : Journal of the Association of AmericanMedical Colleges, 90(10), 1302\u0026ndash;1308. https://doi.org/10.1097/ACM.0000000000000759\u003c/li\u003e\n\u003cli\u003eMoher, D., Naudet, F., Cristea, I. A., Miedema, F., Ioannidis, J. P. A., \u0026amp; Goodman, S. N. (2018). Assessing scientists for hiring, promotion, and tenure. PLoS Biology, 16(3). https://doi.org/10.1371/journal.pbio.2004089\u003c/li\u003e\n\u003cli\u003eMukherjee, B. (2016). RANKING INDIAN UNIVERSITIES THROUGH RESEARCH AND PROFESSIONAL PRACTICES OF NATIONAL INSTITUTIONAL RANKING FRAMEWORK (NIRF): A CASE STUDY OF SELECT CENTRAL UNIVERSITIES IN INDIA. In JOURNAL OF INDIAN LIBRARY ASSOCIATION (Vol. 52, Issue 4). http://www.tezu.ernet.in/ugc_data/ANNEXUREVI.pdf;\u003c/li\u003e\n\u003cli\u003ePassi, V., Johnson, S., Peile, E., Wright, S., Hafferty, F., \u0026amp; Johnson, N. (2013). Doctor role modelling in medical education: BEME Guide No. 27. Medical Teacher, 35(9). https://doi.org/10.3109/0142159X.2013.806982\u003c/li\u003e\n\u003cli\u003ePololi, L. H., Evans, A. T., Civian, J. T., Gibbs, B. K., Coplit, L. D., Gillum, L. H., \u0026amp; Brennan, R. T. (2015). Faculty Vitality-Surviving the Challenges Facing Academic Health Centers: A National Survey of Medical Faculty. Academic Medicine, 90(7), 930\u0026ndash;936. https://doi.org/10.1097/ACM.0000000000000674\u003c/li\u003e\n\u003cli\u003eQuan, W., Chen, B., \u0026amp; Shu, F. (n.d.). Publish or impoverish- An investigation of the monetary reward system of science in China (1999-2016). https://arxiv.org/ftp/arxiv/papers/1707/1707. 01162.pdf\u003c/li\u003e\n\u003cli\u003eSalajegheh, M., Gandomkar, R., Mirzazadeh, A., \u0026amp; Sandars, J. (2020). Identification of capacity development indicators for faculty development programs: A nominal group technique study. BMC Medical Education, 20(1). https://doi.org/10.1186/s12909-020-02068-7\u003c/li\u003e\n\u003cli\u003eSalajegheh, M., Hekmat, S. N., \u0026amp; Macky, M. (2022). Challenges and solutions for the promotion of medical sciences faculty members in Iran: a systematic review. BMC Medical Education, 22(1). https://doi.org/10.1186/s12909-022-03451-2\u003c/li\u003e\n\u003cli\u003eSchimanski, L. A., \u0026amp; Alperin, J. P. (2018). The evaluation of scholarship in academic promotion and tenure processes: Past, present, and future. F1000Research, 7. https://doi.org/10.12688/f1000research.16493.1\u003c/li\u003e\n\u003cli\u003eShafian, S., \u0026amp; Salajegheh, M. (2021). Faculty Members\u0026rsquo; Promotion: Challenges and Solutions. In Strides in Development of Medical Education Journal (Vol. 18, Issue 1). Kerman University of Medical Sciences. https://doi.org/10.22062/sdme.2021.195223.1033\u003c/li\u003e\n\u003cli\u003eSimpson, D., Fincher, R.-M. E., Hafler, J. P., Irby, D. M., Richards, B. F., Rosenfeld, G. C., \u0026amp; Viggiano, T. R. (2007). Advancing educators and education by defining the components and evidence associated with educational scholarship. Medical Education, 41(10), 1002\u0026ndash;1009.\u003c/li\u003e\n\u003cli\u003eSt\u0026uuml;rmer, S., Oeberst, A., Tr\u0026ouml;tschel, R., \u0026amp; Decker, O. (2017). Early-Career Researchers\u0026rsquo; Perceptions of the Prevalence of Questionable Research Practices, Potential Causes, and Open Science. Social Psychology, 48(6).\u003c/li\u003e\n\u003cli\u003eTijdink, J. K., Schipper, K., Bouter, L. M., Pont, M., De Jonge, J., Smulders, Y. M., \u0026amp; Tijdink@, ; J. (2016). How do scientists perceive the current publication culture? A qualitative focus group interview study among Dutch biomedical researchers. BMJ Open, 6(2). https://doi.org/10.1136/bmjopen-2015\u003c/li\u003e\n\u003cli\u003eTootoonchi, M., Yamani, N., Changiz, T., Taleghani, F., \u0026amp; Mohammadzadeh, Z. (2014). Assessment of educational criteria in academic promotion: Perspectives of faculty members of medical sciences universities in Iran. Journal of Education and Health Promotion, 3(1), 29. https://doi.org/10.4103/2277-9531.131893\u003c/li\u003e\n\u003cli\u003eWerner, M. U. (2021). Salami-slicing and duplicate publication: Gatekeepers challenges. In Scandinavian Journal of Pain (Vol. 21, Issue 2, pp. 209\u0026ndash;211). De Gruyter Open Ltd. https://doi.org/10.1515/sjpain-2020-0181\u003c/li\u003e\n\u003cli\u003eZibrowski, E. M., Weston, W. W., \u0026amp; Goldszmidt, M. A. (2008). \u0026ldquo;I don\u0026rsquo;t have time\u0026rdquo;: issues of fragmentation, prioritisation and motivation for education scholarship among medical faculty. Medical Education, 42(9), 872\u0026ndash;878. https://doi.org/10.1111/J.1365-2923.2008.03\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Faculty promotion, Medical Teaching Institutes (MTIs), research challenges, educational activities, Cultural-Historical Activity Theory (CHAT)","lastPublishedDoi":"10.21203/rs.3.rs-6187481/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6187481/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction:\u003c/p\u003e\n\u003cp\u003eThis research analyses the promotion challenges for faculty in Medical Teaching Institutes (MTIs) of Khyber Pakhtunkhwa (KP), Pakistan. The MTI Act prioritises research achievements, clinical skills, continuous professional development (CPD), and academic performance. However, faculty faces hurdles in meeting these criteria due to vague guidelines, overemphasising research publications, and insufficient institutional support.\u003c/p\u003e\n\u003cp\u003eObjective:\u003c/p\u003e\n\u003cp\u003eTo identify challenges associated with faculty promotion in MTIs related to research and educational activities\u003c/p\u003e\n\u003cp\u003eMethods:\u003c/p\u003e\n\u003cp\u003eA qualitative study utilised semi-structured interviews with ten faculty members promoted or in the promotion process under MTI criteria and ten faculty promotion committee members. The data was analysed through the Cultural-Historical Activity Theory (CHAT) framework, concentrating on institutional, cultural, and historical factors affecting faculty experiences.\u003c/p\u003e\n\u003cp\u003eResults:\u003c/p\u003e\n\u003cp\u003eEighteen codes and subthemes were identified, leading to twelve final themes. Key themes included ambiguities in promotion criteria, a focus on high-impact research, and difficulty balancing teaching, research, and clinical roles. Insufficient institutional support exacerbates these issues. The promotion criteria inadequately address local healthcare needs and undervalue community engagement.\u003c/p\u003e\n\u003cp\u003eDiscussion:\u003c/p\u003e\n\u003cp\u003eThe MTI faculty promotion criteria, differing from previous standards, emphasise research and academic activities. This criterion aligns with emerging trends in higher education but presents challenges. The focus on research leads to an imbalance in clinical commitments and educational activities. Additionally, limited resources, institutional culture, and support hinder faculty from meeting promotion criteria. Subjectivity surrounding specific requirements also raises concerns about transparent implementation.\u003c/p\u003e\n\u003cp\u003eConclusion:\u003c/p\u003e\n\u003cp\u003eThe research highlights the need to adjust MTI promotion standards to be adaptable and acknowledge local contributions. Improving transparency, supporting faculty development, and aligning with healthcare education goals are essential for a more effective academic environment.\u003c/p\u003e","manuscriptTitle":"Challenges presented by the promotion criteria in Medical Teaching Institutes (MTIs) of Khyber Pakhtunkhwa (KP) to the research and academics of the faculty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-24 10:16:01","doi":"10.21203/rs.3.rs-6187481/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f4c69a18-459b-4226-9397-7f972b537874","owner":[],"postedDate":"April 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T02:23:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-24 10:16:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6187481","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6187481","identity":"rs-6187481","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}